1/123. Acute pseudohepatitis in a chronic substance abuser secondary to occult seat belt injury.Causes of a massive elevation in serum aminotransferases (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) in the substance-abusing patient include viral hepatitis and drug hepatotoxicity. A patient chronically addicted to injection heroin and cocaine presented to the emergency room in a confused state and was admitted to a medical ward with an AST of 4120 U/L, ALT 3820 U/L and right upper quadrant discomfort. Investigations for viral and hepatotoxic causes for the liver dysfunction revealed only hepatitis c seropositivity. A computed tomogram of the abdomen, however, revealed a significant contusion to the right lobe of the liver consistent with traumatic injury. A motor vehicle accident, in which the patient was wearing a seat belt, and which had occurred a few days before admission and had been thought to be minor, was the cause of the liver dysfunction. Significant blunt abdominal traumatic injuries are usually managed exclusively by surgical trauma units. This case underlines the need for medical specialists to be aware of hepatic contusion injuries and to have a high index of suspicion when investigating unexplained hepatocellular dysfunction in chronic substance abusers who have been in motor vehicle accidents.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
2/123. Iatrogenic drug dependence--a problem in intensive care? Case study and literature review.Use of sedative and analgesic pharmacological agents is a widespread practice in intensive care units (ICUs). Mainly, this involves opioid and benzodiazepine analogues, both known to induce dependence/tolerance states. This paper is based on a clinical scenario in which a patient treated with these agents developed problems when they had been discontinued, and exploration of the extent of such problems generally. The problems range across a wide range of domains and may include physical discomfort, difficulty weaning from respiratory assistance and the drugs, and the problems of short- and long-term psychological distress. Although there may be a recognition that these drugs can typically cause dependence problems, little emphasis has traditionally been given to assessing these problems in ICUs. Yet the ICU may be an area where these drugs are used in high volumes. The recognition, physiology, management and prevention of iatrogenic drug dependence/tolerance in critical care environments is elucidated, with reference to relevant literature.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
3/123. Substance abuse and emergency psychiatry.Given the high rates of comorbidity, patients commonly present with multiple diagnoses to PESs or crisis services. Clinicians must be well versed in the evaluation, differential diagnosis, and treatment of patients with substance-abuse disorders or other axis I, II, or III conditions if they are to provide state-of-the-art treatment of patients in need of emergency care.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
4/123. Asphyxial death during prone restraint revisited: a report of 21 cases.Determining the cause of death when a restrained person suddenly dies is a problem for death investigators. Twenty-one cases of death during prone restraint are reported as examples of the common elements and range of variation in these apparently asphyxial events. A reasonable diagnosis of restraint asphyxia can usually be made after ruling out other causes and collecting supportive participant and witness statements in a timely fashion. Common elements in this syndrome include prone restraint with pressure on the upper torso; handcuffing, leg restraint, or hogtying; acute psychosis and agitation, often stimulant drug induced; physical exertion and struggle; and obesity. Establishing a temporal association between the restraint and the sudden loss of consciousness/death is critical to making a correct determination of cause of death.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
5/123. Managing addiction in advanced cancer patients: why bother?The management of addiction in patients with advanced cancer can be time-consuming, labor-intensive, and difficult. Some clinicians believe that it is not worth the effort, due in part to a failure to appreciate the deleterious impact of addiction on palliative care efforts and a view of addiction as intractable in any case. Indeed, it is possible that some clinicians perceive addiction not only fatalistically but, because of common misconceptions, believe that managing or attempting to decrease the patient's use of alcohol or illicit substances would be tantamount to depriving a dying patient of a source of pleasure. In this paper, we argue that managing addiction is an essential aspect of palliative care for chemically-dependent and alcoholic patients. The goal of such efforts is not complete abstinence, but exerting enough control over illicit drug and alcohol use to allow palliative care interventions to decrease suffering. To illustrate this view, we describe two patients with chemical-dependency. We highlight the impact of unchecked substance abuse on patients' perpetuation of their own suffering, the complication of symptom management, the diagnosis and treatment of mood/anxiety disorders, and the effect on the patients' family and caregivers.- - - - - - - - - - ranking = 1181.3563334584keywords = anxiety, anxiety disorder (Clic here for more details about this article) |
6/123. naltrexone treatment of dementia with severe self-injurious behaviors: a single case study.The results of studies of the opiate antagonist naltrexone (NLTX) in the treatment of self-injurious behavior (SIB) in various psychiatric populations have been equivocal. The majority of studies has relied on small samples, many of which lacked scientific rigor and none of which occurred in a nursing facility. The present study investigates the use of NLTX on a patient with severe SIB who resides in a nursing facility. The patient is a 38-year-old male with a history of heavy drug and alcohol abuse. He has been in either a state hospital or nursing facility since age 21. The patient overdosed on alcohol and drugs in 1990, which led to a prolonged coma with organic brain damage.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
7/123. Reversible hypogonadism and azoospermia as a result of anabolic-androgenic steroid use in a bodybuilder with personality disorder. A case report.We report a case of reversible hypogonadism and azoospermia resulting from anabolic-androgenic steroid abuse in a body-builder with primary personality disorder. A keen body builder, a 20-year-old man, developed acute aggressive and destructive behavior after 10-month use of Bionabol (mean total dose of 1,120 mg per month), and Retabolil (mean total dose of 150 mg per month). He was found to meet the diagnostic and statistical manual of mental disorders-IV ed. (DSM-IV) criteria for borderline personality disorder. On admission to the hospital the clinical profile of the patient showed extremely low levels of serum testosterone. Values increased to normal levels 10 months after withdrawal of steroids. The semen was azoospermic at the beginning of the study period, oligospermic five months later, and reached 20 x 10(6) sperm per mL ten months after the steroid discontinuation. Anabolic steroids can greatly affect the male pituitary-gonadal axis. A hypogonadal state, characterized by decreased serum testosterone and impaired spermatogenesis, was induced in the patient. This condition was reversible after the steroid withdrawal, but the process took more than ten months. His personal imbalance could be considered a personality trait rather than a result of the anabolic-androgenic steroid use. There were probably dispositional personality characteristics that contributed to anabolic steroid abuse in our patient. The hypogonadal changes which occurred after his long-term steroid abuse were for the most part reversible.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
8/123. Chronic addiction relapse treatment: a study of the effectiveness of the high-risk identification and prediction treatment model. Part II. The HRIPTM case table, case study examples and questionnaire.The high-risk identification and prediction treatment model (HRIPTM) was developed to investigate the physiological and psychological conditions associated with the concept of negative emotional state, and to examine the origin and evolution of this condition in relation to addiction relapse. An in depth case study sample of n=30 was conducted within the context of an intensive outpatient addiction treatment program based on the HRIPTM. The HRIPTM investigates the nature of problematic repetitive behavior patterns originating in the childhood developmental period, the individual nature of negative emotional state in relation to these patterns and their evolution, and their influence on addiction vulnerability and addiction relapse. The preliminary study upon which this model was based emphasized the importance of developing methods for accumulating information that pinpoints lifespan experiences associated with the origin of problematic behaviors, the level of emotional intensity factors associated with behavior pattern construction and development, and level of associated risk potential as it manifests in each individual case.Recent neuroscientific studies into the early developmental process are producing increased evidence of the enormous influence of this period on later developmental processes. Addiction, in itself a developmental process, may be more influenced by pre-addiction factors than previously assumed. This model addresses those influences. The study was conducted to determine whether or not information that arises from the HRIPTM increases the patient's and clinician's ability to address addiction relapse more effectively. As a result of completion of the HRIPTM program, the sample n=30 reported gained ability to address recovery processes more effectively. The 12-question HRIPTM Questionnaire instrument, when tabulated, revealed that of the 360 total responses, less than 2% disagreed that ability had been gained in all suggested areas defined in the questionnaire. Over 98% agreed or strongly agreed that ability had been gained in the defined areas.- - - - - - - - - - ranking = 2keywords = state (Clic here for more details about this article) |
9/123. GHB. Club drug or confusing artifact?GHB can be produced either as a pre- or postmortem artifact. The authors describe two cases in which GHB was detected and discuss the problem of determining the role of GHB in each case. In both cases, NaF-preserved blood and urine were analyzed using gas chromatography. The first decedent, a known methamphetamine abuser, had GHB concentrations similar to those observed with subanesthetic doses (femoral blood, 159 microg/ml; urine, 1100 microg/ml). Myocardial fibrosis, in the pattern associated with stimulant abuse, was also evident. The second decedent had a normal heart but higher concentrations of GHB (femoral blood, 1.4 mg/ml; right heart, 1.1 mg/ml; urine, 6.0 mg/ml). blood cocaine and MDMA levels were 420 and 730 ng/ml, respectively. Both decedents had been drinking and were in a postabsorptive state, with blood to vitreous ratios of less than 0.90. If NaF is not used as a preservative, GHB is produced as an artifact. Therefore, the mere demonstration of GHB does not prove causality or even necessarily that GHB was ingested. blood and urine GHB concentrations in case 1 can be produced by a therapeutic dose of 100 mg, and myocardial fibrosis may have had more to do with the cause of death than GHB. The history in case 2 is consistent with the substantial GHB ingestion, but other drugs, including ethanol, were also detected. ethanol interferes with GHB metabolism, preventing GHB breakdown, raising blood concentrations, and making respiratory arrest more likely. Combined investigational, autopsy, and toxicology data suggest that GHB was the cause of death in case 2 but not case 1. Given the recent discovery that postmortem GHB production occurs even in stored antemortem blood samples (provided they were preserved with citrate) and the earlier observations that de novo GHB production in urine does not occur, it is unwise to draw any inferences about causality unless (1) blood and urine are both analyzed and found to be elevated; (2) blood is collected in NaF-containing tubes; and (3) a detailed case history is obtained.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
10/123. Prolonged psychosis attributed to phencyclidine: report of three cases.After ingesting street drugs sold as "PCP," "THC," and "methadone," three young men developed schizophreniform psychoses, analgesia, anesthesia, and amnesia for the psychotic state. Except for their unusually long duration of 2 to 4 weeks, these reactions resembled phencyclidine psychoses. The authors are aware of other phencyclidine-related hospital admissions but could find no information on phencyclidine in recently published handbooks on drug abuse.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
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